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Research Objective The COVID‐19 pandemic forced a dramatic shift from in‐person care to telehealth, with an overall decrease in outpatient utilization. These changes particularly stressed outpatient care delivery and may have resulted in decreased availability and access to primary care for patients, potentially increasing otherwise avoidable emergency department (ED) visits and hospitalizations. One commonly used indicator of primary care access and quality is acute care visits for ambulatory care‐sensitive conditions (ACSCs), such as for pneumonia, uncontrolled diabetes, or congestive heart failure exacerbations. Our study examined differences in telehealth adoption across practices and evaluated the association between telehealth adoption and ACSC visits. TABLE 1 Differences‐in‐differences model of practice telemedicine conversion rate on acute care visits for acute and chronic ACSCs Acute ACSC aOR (95% CI) Chronic ACSC aOR (95% CI) Telemedicine tertile (mean telemedicine conversion rate) Low (9%) ref ref Medium (30%) 0.98 (0.91–1.07) 0.98 (0.76–1.26) High (66%) 1.07 (0.98–1.17) 1.14 (0.86–1.50) Study Design We conducted a retrospective study of claims data from a large commercial insurer in Michigan. We first profiled telehealth adoption by primary care practices during March–July 2020. We defined a practice's “telehealth conversion rate” as the proportion of visits conducted via telehealth during this period compared to the total number of visits during the same period in 2019. Then, to enable comparison between groups at a time when both outpatient and acute care visits were in flux, we used a differences‐in‐differences (DID) model to determine whether varying levels of primary care telehealth conversion were associated with differences in acute care visits (ED visits and hospitalizations) for ACSCs from June–September 2020. We examined visit rates for acute and chronic ACSCs separately, controlling for practice size, in‐person visit volume, and zip code‐level attributes as well as patient characteristics (age, gender, comorbidities). We performed sensitivity analyses using varying definitions of telemedicine conversion rates and multiple model specifications. Population Studied Six million Blue Cross Blue Shield of Michigan beneficiaries across 3780 primary care practices from January 2019 to September 2020. Principal Findings Average primary care practice telehealth conversion rate was 25% (median 10%), and 29% of practices had no telehealth claims identified. Practices that did not adopt telehealth tended to be smaller and were more likely to be in rural areas. We found no significant differences in the rate of ED visits and hospitalizations for ACSCs by practice‐level telemedicine conversion tertile after adjusting for practice case‐mix, as shown in Table 1. Sensitivity analyses showed similar results. Conclusions Beneficiaries within a large commercial payer experienced rapid shifts from in‐person to telehealth for their primary care, though telehealth adoption was not evenly distributed, with smaller and more rural practices being less likely to adopt telemedicine. These changes did not seem to obviously help or harm patients as ED visits and hospitalizations for ACSCs were similar across groups. Implications for Policy or Practice Widespread substitution of telehealth for in‐person care had little impact on cost of care with respect to avoidable ED visits and hospitalizations in the near‐term. Additional research should continue to monitor this trend as health care utilization stabilizes beyond the pandemic. Primary Funding Source University of Michigan Institute for Health Policy and Innovation.

We experimentally address the theoretical potential for managing ecosystem engineer species to support suites of species in degraded habitats. Historically, the ecosystem engineer California ground squirrel Otospermophilus beecheyi supported a grassland food web through widespread burrowing activity. Currently, ground squirrels are not a threatened species, but like many other ecosystem engineers, they exist at densities too low to fulfill their engineering role in many locations. Our objective was to implement short-term treatments, including squirrel translocation, to re-establish key ecological processes on protected reserve lands. We manipulated vegetation and squirrels in a replicated, large-scale field experiment for 2 years, and monitored through a third year. Vegetation mowing and soil decompaction treatments reduced grass density and thatch depth. Squirrel translocation accelerated squirrel settlement and activity in target sites. Of the more than 1000 burrow entrances remaining through the third year, nearly all burrows were concentrated in the plots that received squirrel translocation. We found significant additive effects of squirrel translocation and vegetation management on the spatial footprint of squirrel activity. Noteworthy and persistent engineering effects were achieved through squirrel activity, and both vegetation management and squirrel re-establishment were needed to stimulate squirrel activity. The overarching goal of this experiment was to provide conservation managers with a cost-effective tool for restoring degraded habitats to a hybrid ecosystem state with improved suitability for species of conservation concern, in this case, the western burrowing owl Athene cunicularia hypugaea.

Objective We addressed two questions regarding health system consolidation through the acquisition of ambulatory clinics: (1) Was increasing health system size associated with improved diabetes care performance and (2) Did the diabetes care performance of acquired clinics improve postacquisition? Data Sources/Study Setting Six hundred sixty-one ambulatory clinics in Minnesota and bordering states that reported performance data from 2007 to 2013. Study Design We employed fixed effects regression to determine if increased health system size and being acquired improved clinics' performance. Using our regression results, we estimated the average effect of consolidation on the performance of clinics that were acquired during our study. Data Collection/Extraction Methods Publicly reported performance data obtained from Minnesota Community Measurement. Principal Findings Acquired clinics experienced performance improvements starting in their third year postacquisition. By their fifth year postacquisition, acquired clinics had 3.6 percentage points (95 percent confidence interval: 2.0, 5.1) higher performance than if they had never been acquired. Increasing health system size was associated with slight performance improvements at the end of the study. Conclusions Health systems modestly improved the diabetes care performance of their acquired clinics; however, we found little evidence that systems experienced large, system-wide performance gains by increasing their size.

Health information technology (IT) adoption, it is argued, will dramatically improve patient care. We study the impact of hospital IT adoption on patient outcomes focusing on the role of patient and organizational heterogeneity. We link detailed hospital discharge data on all Medicare fee-for-service admissions from 2002–2007 to detailed hospital-level IT adoption information. For all IT-sensitive conditions, we find that health IT adoption reduces mortality for the most complex patients but does not affect outcomes for the median patient. Benefits from health IT are primarily experienced by patients whose diagnoses require cross-specialty care coordination and extensive clinical information management.

Purpose We sought to examine the demographic, market, and policy-related factors influencing first year enrollment rates for the population targeted by the Health Insurance Marketplaces (HIMs) established as part of the Affordable Care Act. In particular, we analyzed differences in enrollment rates across urban and rural counties in 32 states served by the Federally Facilitated Marketplace. Methods We used enrollment data from the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services and demographic data from the American Community Survey, supplemented with other market and policy-related information. Using multivariate regression, we investigated how county-level enrollment rates are associated with demographic, market and policy-related characteristics, including rurality. Findings Relative to an adjusted mean enrollment rate of 17.1% for large metropolitan counties, small metropolitan counties have a 2.8% lower enrollment rate and rural counties have a 2.7% lower enrollment rate. States’ decisions to expand Medicaid and to have the federal government fully manage the HIM are both negatively associated with enrollment rates. Partnership HIMs exhibit a positive association with enrollment rates as do navigator grants, but the latter relationship is only present in counties located in Medicaid expansion states. Conclusions Enrollment rates vary by rurality, but differences are statistically significant only between large metropolitan counties and all other types of counties—small metropolitan, micropolitan, and noncore. State-level policies, particularly Medicaid expansion, have the largest association with enrollment rates among the explanatory variables examined in the model.

Purpose To examine the role of Regional Extension Centers (RECs) in helping rural physician practices adopt electronic health records (EHRs) and achieve meaningful use. Methods Using data from the Office of the National Coordinator for Health Information Technology, we conducted a county-level regression analysis using ordinary least squares to better understand rural-urban differences in REC participation, EHR implementation, and meaningful use, controlling for counties’ economic conditions. We prepared case studies of 2 RECs that are serving a large number of rural practices, based on interviews with key individuals at the RECs, their partner organizations, and rural primary care practices that received assistance from the RECs. Findings RECs are largely achieving their objective of targeting providers in communities that face barriers to EHRs. REC participants are disproportionately rural and more likely to come from high poverty and low employment communities. The case study RECs had long-standing relationships with rural providers, as well as extensive staff expertise in quality improvement and EHR implementation, and employed a variety of strategies to successfully assist rural providers. Rural providers report that REC assistance was invaluable in helping them implement EHRs and achieve meaningful use status. Conclusion Modifying the criteria for Medicare and Medicaid EHR incentives could help additional rural providers pay for EHRs. REC federal funding is scheduled to end in 2014, but practices that have not yet adopted EHRs may need significant, ongoing assistance to receive meaningful use.

The US health care sector is, by most accounts, extraordinarily inefficient. Health information technology (IT) has been championed as a tool that can transform health care delivery. Recently, the federal government has taken an active role in promoting health IT diffusion. There is little systematic analysis of the causal impact of health IT on productivity or whether private and public returns to health IT diverge thereby justifying government intervention. We estimate the parameters of a value-added hospital production function correcting for endogenous input choices in order to assess the private returns hospitals earn from health IT. Despite high marginal products, the potential benefits from expanded IT adoption are modest. Over the span of our data, health IT inputs increased by more than 210% and contributed about 6% to the increase in value-added. Virtually all the increase in value-added is attributable to the increased use of inputs{there was little change in hospital multi-factor productivity. Not-for-profits invested more heavily and differently in IT than for-profit hospitals. Finally, we find no evidence of labor complementarities or network externalities from health IT.

Williams-Beuren syndrome is a well-known microdeletion syndrome with a recognizable clinical phenotype. The subtle phenotype of the reciprocal microduplication of the Williams-Beuren critical region has been described recently. We report seven further patients, and a transmitting parent, with 7q11.23 microduplication. All our patients had speech delay, autistic features and facial dysmorphism consistent with the published literature. We conclude that the presence of specific dysmorphic features, including straight, neat eyebrows, thin lips and a short philtrum, in our patients with speech delay and autistic features provides further evidence that the children with 7q11.23 microduplication have a recognizable phenotype.

Up-regulation of vascular endothelial growth factor (VEGF) is important to hepatocyte regeneration in the late stages of acetaminophen (APAP) toxicity in the mouse. This study was conducted to examine the relationship of hypoxia-inducible factor 1α (HIF-1α) to VEGF and hepatocyte regeneration in APAP toxicity using an inhibitor of HIF-1α DNA-binding activity, echinomycin (EC). B6C3F1 male mice were treated with APAP (200 mg/kg IP), followed by EC (0.15 mg IP) and killed at 4 hr. Serum alanine aminotransferase (ALT), necrosis, hepatic glutathione (GSH) and APAP protein adducts were comparable in the APAP/EC and the APAP/veh mice at 4 hr. Additional studies showed that high dose EC (0.3 mg) reduced hepatic VEGF but also lowered hepatic GSH. Subsequent studies were performed using the 0.15-mg dose of EC. Although EC 0.15 mg had no effect on hepatic VEGF levels at 8 hr, by 24 hr VEGF levels were decreased by 40%. Toxicity (ALT and histopathology) was comparable in the APAP and APAP/EC groups at 24 and 48 hr. Proliferating cell nuclear antigen expression was reduced by both Western blot analysis and immunohistochemical staining in the APAP/EC mice at 48 hr. The data support the hypothesis that induction of HIF-1α, its binding to DNA and subsequent expression of VEGF are important factors in hepatocyte regeneration in APAP toxicity in the mouse.

Dietary flaxseed has cardioprotective effects that may be achieved through its rich content of the omega-3 fatty acid, alpha linolenic acid (ALA). Because ALA can be stored in adipose tissue, it is possible that some of its beneficial actions may be due to effects it has on the adipose tissue. We investigated the effects of dietary flaxseed both with and without an atherogenic cholesterol-enriched diet to determine the effects of dietary flaxseed on the expression of the adipose cytokines leptin and adiponectin. Rabbits were fed one of four diets: a regular (RG) diet, or a regular diet with added 0.5% cholesterol (CH), or 10% ground flaxseed (FX), or both (CF) for 8 weeks. Levels of leptin and adiponectin expression were assessed by RT-PCR in visceral adipose tissue. Consumption of flaxseed significantly increased plasma and adipose levels of ALA. Leptin protein and mRNA expression were lower in CH animals and were elevated in CF animals. Changes in leptin expression were strongly and positively correlated with adipose ALA levels and inversely correlated with levels of en face atherosclerosis. Adiponectin expression was not significantly affected by any of the dietary interventions. Our data demonstrate that the type of fat in the diet as well as its caloric content can specifically influence leptin expression. The findings support the hypothesis that the beneficial cardiovascular effects associated with flaxseed consumption may be related to a change in leptin expression.

Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data from the American Hospital Association (AHA) Annual Survey IT Supplement were analyzed, using t tests and probit regressions to assess whether implementation rates in CAHs and other rural hospitals are significantly different from rates in urban hospitals. Findings: Of the many measures we examined, only 4 have been met by a majority of rural hospitals: electronic recording of patient demographics and electronic access to lab reports, radiology reports, and radiology images. Meaningful use is even less prevalent among CAHs. We also find that rural hospitals lag behind urban institutions in nearly every measure of meaningful use. These differences are particularly large and significant for CAHs. Conclusion: The meaningful use incentive system creates many challenges for CAHs. First, investments are evaluated and subsidies determined after adoption. Thus, CAHs must accept financial risk when adopting health IT; this may be particularly important for large expenditures. Second, the subsidies may be low for relatively small expenditures. Third, since the subsidies are based on observable costs, CAHs will receive no support for their intangible costs (eg, workflow disruption). A variety of policies may be used to address these problems of financial risk, uncertain returns in a rural setting, and limited resources.

To determine the importance of tumour necrosis factor receptor 1 in hepatocyte regeneration in acetaminophen toxicity, wild type and tumour necrosis factor receptor 1 knock-out mice were dosed with acetaminophen (300 mg/kg intraperitoneally) and sacrificed at 4, 24, 48, 72, and 96 hr. Biochemical parameters (alanine aminotransferase, ALT) and histologic evidence of hepatocellular injury were comparable in the two groups of mice. To examine the effects of tumour necrosis factor receptor 1 on hepatocyte regeneration, immunohistochemical staining with proliferating cell nuclear antigen was performed. Immunohistochemical staining for proliferating cell nuclear antigen was significantly reduced at multiple time points in the knock-out mice and did not normalize until 96 hr. To evaluate the effect of tumour necrosis factor receptor 1 depletion on cytokines known to be involved in regeneration, levels of macrophage inhibitory protein 2, interferon-gamma-inducible protein-10 and monocyte chemoattractant protein 1 were compared in the two groups of mice. Significant elevation of all cytokines was observed in both groups of mice; however, higher levels were present in the knock-out mice. Depletion of tumour necrosis factor receptor 1 has long-lasting effects on hepatocyte regeneration in acetaminophen toxicity but multiple other factors appear to orchestrate eventual recovery in these mice.

To evaluate the effectiveness of microwave irradiation in dissociating IgG from red cells (RBCs), the use of chloroquine diphosphate (CDP) was compared to that of microwaves. Fifteen paired samples of RBCs from 15 patients with positive direct antiglobulin tests (DATs) were treated with both CDP and microwave radiation. Total microwave exposure times ranged from 20 to 100 seconds. Posttreatment DATs were performed, and the reaction grades of the posttreatment DATs were compared. RBC phenotyping was also performed on repeatedly microwaved RBCs to demonstrate possible effects on RBC antigen expression. Microwaves successfully reduced the reaction grade of the DAT in 14 of 15 samples; CDP reduced the reaction grade in 12 of 15 samples. In samples with a DAT of 2+ or greater (n = 13), the microwave method yielded a greater reduction in DAT strength in six cases (results in the other 7 cases were identical with both methods) (p = 0.01). Five of eight cases with a DAT of 3+ showed a greater reduction in the DAT with microwave treatment than with CDP treatment; results in the remaining three cases were identical (p = 0.03). RBC antigenicity remained unchanged after exposure to microwave radiation (A, B, C, c, D, E, e, Fya, Fyb, Jka, Jkb, K, k, S, and s). Microwave treatment required less than 10 minutes per sample, while CDP treatment required 30 to 120 minutes per sample (mean, 88 min). The microwave technique of antigen-antibody dissociation from RBCs provides a rapid and accurate method of facilitating the phenotyping of RBCs coated with warm autoantibodies and is superior to other methods, which destroy RBC antigens.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to define current issues and outcomes of living kidney donation, 100 consecutive living donors operated on between July 1996 and March 2001 were evaluated. The 64 women and 36 men ranged in age from 19 to 72 yr (mean 42.5 yr), and 65 were related to the recipient while 35 were unrelated donors. Hospital admission the morning of surgery and use of a minimal open approach to the donor kidney were standard, as were post-operative epidural pain control and plans for short hospital stay. The 100 donors were hospitalized for 2 (25), 3 (48), 4 (18), 5 (8), or 6 (1) days, with an average length of stay of 3.12 d (range 2-6 d). The mean charge for kidney donor hospitalization was 14,470 dollars (range 9671-22,808 dollars). There were no major intra or immediate post-operative complications. Six rehospitalizations occurred for post-donation nausea, vomiting, dehydration (n = 2); spinal headache; pneumonia and wound haematoma; and late wound reexploration (one hernia and one nerve entrapment). All donors returned to pre-operative functional status within 6 d to 6 wk of donation. All kidneys functioned immediately in the 100 recipients (50 women, 50 men) who averaged 46.6 yr of age (range 17-69 yr); recipient length of stay averaged 3.81 d (range 2-15 d). All donors survived in excellent health; recipient graft and patient survival, respectively, are 87 and 90% through the entire 5-yr period. Excellent long-term outcomes for living kidney donors may be accomplished using minimal open surgical technique, post-operative epidural pain control and plans for a brief hospitalization. Expansion of living donor resources in renal transplant programs may grow as unrelated kidney donation and non-directed donation as well as minimally invasive (open and laparoscopic) techniques evolve.

(1) While Alzheimer's disease (AD) is devastating for those who acquire it, AD can be equally devastating for the caregiver, whether that person is a professional or a family member. This article contains synthesized knowledge about the effects of AD on caregivers and the attempts that have been made to create special care units, residential living facilities, and group living arrangements to meet the unique needs of AD patients and their caregivers. While the research regarding caregivers of AD patients and the attempts to provide alternatives to institutionalization are not extensive, the findings presented here have proved to be very useful as a basis for clinical practice and future research.

(1) Alzheimer's disease (AD) is predicted to strike 14 million Americans by 2050. To date, the only accurate way to diagnose this devastating disease is at autopsy, so the importance of ruling out other diseases and instituting a plan of care for early symptoms is vital. The purpose of this review is to synthesize the knowledge about the assessment and diagnosis of Alzheimer's disease so clinicians can understand what is needed to differentiate AD from other diseases/conditions.

The purpose of this synthesis of research findings regarding education of family and staff caregivers of people with Alzheimer's disease (AD) is to provide knowledge about what has been tried and what has been successful in terms of education for both family and staff caregivers. This article provides research findings concerning family and staff education, content of these educational programs, and impact of education on staff and family. The implications of research for practice of nurses are also presented. The article concludes with comments about the nature of research so far and what needs to be accomplished in the future.

(1) The purpose of this review is to present knowledge about the treatment of Alzheimer's disease (AD). Synthesized research findings about the pharmacological and nonpharmacological interventions used with patients who have Alzheimer's disease are presented and are followed by a discussion regarding the actions nurses can initiate to enhance functioning and delay institutionalization. While there is a great deal of interest and study of AD treatment, the research is variable and often with small populations. Even so, the results of these studies are promising, as they provide information about the ways AD symptoms can be controlled by medication and other means.

Fluorescence in situ hybridisation (FISH) detection of MLL translocations is now commonplace in cytogenetics laboratories. One of the most widely used probes is the Oncor MLL probe (Oncor, Gaithersburg, MD) that theoretically demonstrates the presence of an MLL rearrangement by a splitting of the FISH signal between the two derivative chromosomes generated by a translocation. Recently, another commercial probe has been made available from Vysis (Vysis, Downers Grove, IL) that uses a dual colour system. We examined material from 29 patients and 4 cell lines, all with recognised MLL translocations by G-banding, that were confirmed using Southern blot analysis of the MLL breakpoint cluster region. Both Oncor and Vysis MLL FISH probes were applied to these cases to compare their performance in detection of the MLL translocations. Thirty of the 33 cases demonstrated a clear splitting of Oncor MLL FISH signal in concordance with the Southern blot analysis and cytogenetics. Three cases failed to demonstrate a split MLL FISH signal. Therefore, we conclude that the Oncor MLL FISH probe has a 9.1% false negative rate, i.e., 90.9% sensitivity in detection of classic MLL translocations. Vysis MLL FISH detected the rearrangement in all 33 cases.

We report a case of acute myeloid leukemia (AML) M5a showing a jumping translocation with a breakpoint at 11q23. Fluorescence in situ hybridization (FISH) demonstrated triplication of the MLL gene and the presence of interstitial telomeric sequences, supporting the role of repetitive sequences in the mechanism of jumping translocations. Southern blot analysis of the MLL breakpoint cluster region showed the presence of an MLL gene rearrangement. Jumping translocation with MLL gene rearrangement is a previously unreported phenomenon in leukemia cytogenetics. Genes Chromosomes Cancer 24:295–298, 1999. © 1999 Wiley-Liss, Inc.

The demand for public services and physical infrastructure in developing countries is growing steadily as populations increase, and as expectations of achieving better standards of living are raised by national development plans and international assistance programmes. Local services and infrastructure not only contribute to social welfare but also enhance the productivity of labour, allow markets to work more effectively, and create opportunities for employment and entrepreneurship (World Bank, 1975; USAID, 1982). But in many developing countries local services and infrastructure are either provided by central governments ineffectively and inefficiently, or by community organizations and private businesses only sporadically (Moris, 1976; Ayubi, 1982; Harris, 1983). Local institutions often lack the incentives, adequate funds, technical expertise, and management capacity to provide services. Thus in many developing countries there are few services of any kind in areas outside of the national capital (Rondinelli and Ruddle, 1978). Furthermore, the maintenance of physical infrastructure that does exist is notoriously poor in developing countries, and as a result services and facilities deteriorate quickly (Tendler, 1979). The World Bank reports that roads it financed during the 1960s and 1970s are deteriorating so fast that many will be unusable before the borrowing countries can repay the loans for their construction. The cost of needed road maintenance in developing countries is now approaching US$40 billion (Roth, 1987b). The problems of providing and maintaining public services and infrastructure have brought increasing calls for decentralization and

Gangliosides from bovine optic nerve were analyzed. The optic nerve contained 129, 98, 97, 80, 31 and 12 μg of GM1, GD1a, GD1b, GT1b, GD3 and GQ1 gangliosides, respectively, per g of tissue wet wt. These 6 gangliosides altogether contributed 97% of the total sialic acid. GM3 and GM2 gangliosides contributed the remaining 3% of total sialic acid. Stearoyl (18∶0) was the predominant acyl group (61–76%) in all gangliosides. There was a marked variation in acyl group composition between GT1 and most of the other major gangliosides except GD3. In comparison to the other gangliosides, GT1 contained a lower proportion of the stearoyl group and a higher proportion of the oleoyl, nervonoyl and the long chain acyl groups. Both GT1 and GD3 gangliosides contained proportionately higher levels of long chain acyl groups (20∶0→24∶0) than did other gangliosides. GD3 gangliosides showed 2 bands on thin layer chromatography, and the upper band was more distinct than the lower band.

Age-specific secular trend patterns for children in industrialized world regions have a regular pattern, beginning low at age 6 and increasing to a maximum at age 10 to 14, then declining. While magnitude differs, the patterns are ordinarily parallel, especially in the female samples. However, age-specific secular trend values for children from developing regions, or from areas of industrialized countries not benefitting substantially from development, are irregular in pattern and magnitude. Consequently, it is difficult to predict age at maximal secular change. We suggest that fluctuating environmental circumstances in these developing countries influence growth and, hence, the pattern of secular trend. As more stable environmental conditions relating to growth are present in the industrialized countries, this leads to more stable patterns of growth and age-specific patterns of secular change.

Lipids from bovine optic nerve were analyzed. The total content of 16.5% by weight included 27.2% nonpolar lipids, 26.1% glycolipids, and 46.7% phospholipids by weight. Free cholesterol was the major component of the nonpolar lipid fraction. The cerebrosides, 73.5% of total glycolipids, were separated by thin layer chromatography (TLC) into two bands (upper and lower) that were present in equal proportion. Cerebroside sulfates comprised about 27.5% of total glycolipids. Gangliosides were also detected in the glycolipid fraction. In order of predominance, choline glycerophospholipids, ethanolamine glycerophospholipids, ethanolamine plasmalogens, serine glycerophospholipids, sphingomyelins, and inositol glycerophospholipids were the major phospholipids. Palmitoyl (16:0), stearoyl (18:0), and oleoyl (18:1) groups were the major acyl groups in all neutral and phospholipid classes. However, ethanolamine glycerophospholipids, serine glycerophospholipids, and inositol glycerophospholipids contained a large percentage of 22:6 (docosahexaenoyl) group. The major alk-1-enyl groups of the plasmalogens were 16:0, 18:0, and 18:1. Steroyl (18:0), lignoceroyl (24:0), and nervonoyl (24:1) were the major acyl groups in all sphingolipids. Lower cerebroside band and cerebroside sulfates contained large amount of hydroxylignoceroyl (cerebronoyl) and hydroxynervonoyl groups.

The differential diagnosis of odynophagia in patients with malignant disorders usually includes esophagitis due to herpes, Candida, or gastroesophageal reflux. Two cases and a review of the literature are presented that illustrate that leukemic infiltration of the esophagus and necrosis of the esophageal mucosa following chemotherapy should be considered in addition to the more commonly recognized causes. Esophagoscopy with biopsy and brushing for fungal stains is essential for the correct diagnosis since the various causes for odynophagia may be clinically and radiographically indistinguishable.